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Staged Versus Simultaneous Bilateral Deep Brain Stimulation: A Matched Comparison of Outcomes and Resource
Austin M Hilvert1, Sameer Sundrani1, Clayton R Baker1
1Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Neurosurgery
|January 8, 2026
Summary
Staged and simultaneous bilateral deep brain stimulation (DBS) offer similar clinical outcomes for movement disorders. However, staged DBS requires more resources and extends the treatment duration.
Area of Science:
- Neurosurgery
- Neurology
- Medical Technology
Background:
- Deep brain stimulation (DBS) is a key treatment for movement disorders.
- Bilateral DBS implantation is common, but the optimal surgical approach (staged vs. simultaneous) is debated.
Purpose of the Study:
- To compare the clinical outcomes and resource utilization of staged versus simultaneous bilateral DBS procedures.
- To evaluate complications, readmissions, and long-term outcomes for both surgical approaches.
Main Methods:
- Retrospective matched cohort study of 504 patients (252 staged, 252 simultaneous).
- Propensity matching based on age, sex, and diagnosis.
- Data extracted from electronic medical records, including demographics, clinical details, and operative data.
Main Results:
- Staged DBS patients were older and had lower BMI; Parkinson's disease predominated in staged, essential tremor in simultaneous cases.
- Staged DBS was associated with increased anesthesia utilization, operating room time, and hospital days.
- No significant differences were found in intraoperative/postoperative complications, delirium, 30-day readmissions, or reoperation rates between groups.
Conclusions:
- Staged and simultaneous bilateral DBS achieve comparable clinical outcomes.
- Staged procedures incur significantly higher resource utilization and a longer treatment course.
- The choice between staged and simultaneous DBS should consider resource implications alongside clinical efficacy.
